Chad has emerged as a major challenge for the GPEI, with 132 cases of wild poliovirus (WPV) in 2011—the second highest case load behind Pakistan.

Chad has some of the lowest immunization coverage rates in the world, with only 36% of children receiving polio vaccine through routine services. In this context, the quality of polio campaigns becomes even more critical.

UNICEF and WHO are expanding their presence in Chad to meet the polio eradication challenges. Six hubs will be created to improve operations and communication at community level.

Polio campaigns in Chad continue to miss large numbers of children, as demonstrated by ongoing virus transmission, and the low immunity status of AFP cases. Over 10% of non-polio AFP cases in Chad have received no doses of OPV. Although national coverage averages 90%, many provinces continue to miss upwards of 20% of children, particularly in Lac, Salamat, Mayo Kebbi Ouest, Wadi Fira and communities around the capital, N’Djamena (see Figure CHD1).

Why are we missing children?

Service delivery

According to October LQAS data conducted in 14 high risk districts, the major reasons for missed children were “house not visited by vaccination team” (59%) and “child absent” (36%) at the time of vaccinators’ visit. Refusals accounted for only 5% of missed children.

Independent monitoring data conducted nationally, on the other hand, shows child absence as the main reason for missed children, with 62% of children missed for this reason, and 27% of children missed due to “no team” (see Figure CHD2).

Monitoring data from 2011 shows consistently that in areas with low awareness levels (less than 80%), a high proportion of children are missed due to child absent. Logically, parents are not as prepared to participate in the polio eradication effort if they are not aware of the dates of the campaigns (see Figure CHD3).

Demand

The 2011 KAP study conducted in three regions (N’Djamena, Logone Oriental and Moyen Chari) suggests that a combination of low awareness, low threat perception of polio, and concerns over vaccine safety are key issues contributing to low demand for OPV, resulting in low participation in polio campaigns. Findings from qualitative research conducted in the N’Djamena area also suggest that caregivers do not trust vaccinators who come to the door due to their young age, and inability to engage families on issues related to immunization. The study also suggested that in some cases, parents may even be hiding their children from such vaccinators, which could be a contributing factor leading to high rates of child absence.

During 2011, the programme developed provincial level communication strategies and initiated a national mass media strategy, but lacked the human resources to implement at field level. As a result, activities were often ad-hoc, and rolled out without consistency or continuity in terms of programme support. Operational priorities also drew scarce resources away from communication activities.

Microplans at the zone (community), district and regional levels have been weak, and do not include communication activities at planning or implementation level. This is further compounded by the low capacity and lack of supervision of Village Chiefs, who act as both vaccinators and community mobilizers.

Chad also faces low levels of commitment at provincial and district levels, which often cover vast geographic areas lacking basic infrastructure, limited media access and a mostly illiterate population. So far Chad has not faced organized or deeply rooted resistance to OPV. It is therefore likely that the programme will demonstrate progress quickly, once increased resources and stronger management mechanisms can be put in place.

Low campaign awareness continues to be a challenge in Chad. However this is an area where it is possible to make relatively quick gains in increasing the number of parents who can participate in polio campaigns.

National awareness of parents about polio campaigns was up to 86% in the last quarter of 2011, but in some provinces - like Wadi Fira - this rate is as low as 64%.Wadi Fira also missed up to 18% of missed children in recent polio campaigns. Salamat district, which missed 18% of children in November and consistently misses children with rates above the national average, also demonstrates consistently low campaign awareness levels. Only 74% of parents here were aware of the polio campaign in November (see Figure CHD3).

National progress

Although there are low awareness rates in some areas, there has been a gradual improvement nationally over the year, with the percentage of parents aware of the campaigns increasing by 10% (from 79% in February to 86% in November). This trend could be attributed to the intensive implementation of communication and social mobilization interventions through 27 national consultants deployed in the high risk districts across the country.

The main sources of information about polio campaigns in Chad are public announcements through town criers (51%), followed by radio (19%), vaccinators (12%) and religious groups (10%). A combination of mass and interpersonal communication has been intensified in order to reach communities in high priority districts (with awareness rates below 80%) through diverse communication channels. Local radio, TV, cars with loud speakers and town criers who walk through communities conveying campaign dates are utilized to broadcast polio messages. In the highest priority areas, intensive community engagement will be expanded.

Recommendations

Some straightforward improvements in programme quality are likely to achieve results in Chad. The following actions will help ensure Chad is on the right track from the beginning of 2012:

Clearly document under-performing areas, analysing reasons for poor performance, This will help to focus efforts more effectively, in spite of limited resources.

By March 2012, finalize an integrated communication strategy that will focus on increasing demand for OPV through community- based interventions.

By June 2012, implement a robust training plan that will build the capacity of the communication team from N’Djamena to help local efforts to to plan, implement, monitor and report on communication interventions.

Report regularly on the performance of the communication consultants in the field and utilize this data to improve microplanning for future campaigns.